USAID Program for Accelerated Control of TB in Karamoja SUCCESS STORIES DISCLAIMER: USAID PACT-Karamoja made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents of this storybook are the responsibility of IDI and do not necessarily reflect the views of USAID or the United States Government. About PACT-Karamoja Where We Work Period: 2020 - 2025 Funder Project Goal Scale-up evidence-based and high-impact interventions towards the achievement of End TB strategy targets of 90% treatment coverage and treatment success through health system strengthening in all districts of the Karamoja sub-region. Project Objectives Improve treatment success rates to 90% Improve case detection rates to 85% Improve cure rates to at least 70% Our Partners The USAID Program for Accelerated Control of TB in Karamoja (PACT Karamoja) is implemented by the Infectious Diseases Institute Ltd (IDI) with its partner: Dr. Achar, District Health Officer Kotido district receiving one of motor bikes donated by the Project from Chief of Party, USAID PACT-Karamoja. USAID Support Improved TB Patient Tracking Among Nomadic Populations in Karamoja Sub-region Ruto, however, did not give up on finding Margaret. He continued to check if Margaret had returned to her home whenever he visited other TB patients in Kukayim village for adherence support. He also regularly called her next of kin to find out if Margaret had returned from Ochorichor village. After five months of tracking Margaret, Ruto found her back at her home unwell. He encouraged her to return to Amudat hospital for review by the health workers. Margaret is one of the 350 TB patients and more who have been successfully traced by USAID Program for Accelerated Control of TB in Karamoja (PACT Karamoja)’s community teams after failing to keep their monthly clinic appointments. Ruto attributes their success in tracking the patients to teamwork and persistence. “We did not give up the first time when we failed to find her. We continued looking for her.” Ruto says. However, he is also quick to appreciate the enabling support given by the USAID PACT Karamoja activity which facilitates his work. “It is also good that the project provided phones in the TB clinic and airtime. We had to make many phone calls to find Margaret”. In December 2019, 68-year old Aleper Margaret Chepotee from Kukayim village, Ruto in Amudat town was diagnosed with tuberculosis (TB) at Amudat Hospital. Margaret has since restarted her TB treatment and is ready to adhere to the Margaret was immediately started on TB treatment which she dutifully adhered to entire six months of therapy. Ruto continues to provide treatment for the first two months of treatment. But later, she started missing her clinic adherence support since he comes from the same village. Margaret appointments. Realizing that Margaret had missed two clinic visits, the community received health education about TB and now understands that the disease linkage facilitator from Amudat hospital Mr. Ruto Joseph on conducted a home will take six months to cure. She is also happy that Ruto brings her TB visit in an attempt to trace her. medicines at home since Amudat hospital is far. On arrival at her home, he was told that Margaret had traveled to Ochorichor, a “I am happy Ruto brings my medicine all the way up to my home. He also different village 28 kilometers from her home to take care of a sick relative and taught me that stopping to take the medicine was not good. I feel much did not have telephone contact. Efforts to trace her in Ochorichor through the better today after restarting treatment. I will continue on the treatment for community-owned resource person (CORP) overseeing that village was not six months. I will inform Ruto if I have to go away on any other journey”. successful and therefore declared lost to follow up in May 2020. Margaret said USAID - PACT KARAMOJA SUCCESS STORIES Door-to-Door TB screening by Community Owned Resource Persons (CORPs) in Kapakook central village, Kotido district. USAID-PACT Karamoja Collaborating with Community-Owned Resource Persons to Provide TB Services “I suffered with cough, body weakness and joint pain for a while and I thought it was malaria. I only confirmed that I had TB after going for screening” Gabriel Kubal, a resident of Lokodope village in Karenga district narrated. Several people with tuberculosis (TB) in Karamoja do not know that they have the disease. National TB statistics indicate that over 89,000 Ugandans get infected with tuberculosis every year, surpassing the 50,000 who contract HIV annually. With support from the American people, the United States Agency for International Development (USAID) Uganda partnered with Infectious Diseases Institute (IDI) in the USAID PACT Karamoja Activity to build local initiatives towards the reduction of the TB burden in the Karamoja region. Karamoja region is one of the three areas in Uganda cited with a very high rate of TB spread. The region covers 9 districts that is Abim, Amudat, Kaabong, Karenga, Kotido, Moroto, Nabilatuk, Nakapiripirit and Napak. Due to the nomadic way of life of the people in this region, it is difficult to treat and follow up on TB patients as they move from one area to another, taking care of their livestock. As a result, this has led to an increase in spread of TB and a low rate of adherence to medication for people that were diagnosed with TB as well as an increase in the rate of spread of TB within the communities. In an effort to address these challenges, the USAID PACT Karamoja is working with community-owned resource persons (CORPs) who were introduced at the start of the project, to provide TB screening services in high-burden parishes, support referrals from communities to the facilities and work with community leadership to support those on treatment to adhere to their medication. Like many others, Gabriel was identified through active door-to-door screening by a CORP and then referred to the nearby facility where he was diagnosed with TB. Over the last four months, the CORPs in the region have screened over 13,000 people in the communities. They have also encouraged many more to go for TB screening, taught community members the signs and symptoms of the disease as well as ways of supporting the sick people within the communities. “There are many people within the villages that have been referred by their “I am grateful for the support I have received. Lucy encouraged me to go for family and friends with symptoms of TB. Some are able to go to health TB screening at the health centre. I am currently in my third month of centres for treatment however, others are afraid. They require treatment and I hope to continue with my medication as required.” Gabriel encouragement to get screened and treated if diagnosed,” says. He is one of the TB patients currently on treatment at Karenga HCIV enrolled through the CORPs. Lolem Lucy, a CORP working with Karenga HC IV reaching out to people with symptoms of TB or anyone referred within the villages USAID - PACT KARAMOJA SUCCESS STORIES Beneficiary receiving a follow-up call from a health worker. CallforLife Digital Application Motivates TB Patients in Karamoja sub-region to take medicine regularly Isiro Peter is a 61-year-old retired civil servant from Amuria district. For the past TB patients also use this digital intervention to submit a symptom alert three years, Peter has been receiving care for chronic renal disease at Matany to the health worker at the registering facility for any medicine side hospital. In August 2020, Peter developed a cough with chest pain and some effect experienced. Trained healthcare workers provide advice on difficulty in breathing. He reported these symptoms to his local health facility in symptom management or return to the health facilities if warranted. Amuria district from where he was referred to Matany Hospital on suspicion that “Being enrolled onto the CallforLife® digital platform was the beginning he had contracted the dreaded COVID-19 disease. of a new life for me,” says Peter. He relies on the CallforLife service as one would on a friend. His wife and children know the call time, which is “I was in bad shape. I was admitted as a COVID-19 suspect and placed in the 9pm every night. They prepare his dinner early and remind him to eat isolation unit. After a week, I was informed that I did not have COVID-19 but before call time. My wife often says to me, “Eat your food fast, your instead had TB. I was surprised because I never expected to have TB. I was “friend” is about to call.” started on TB treatment and discharged two weeks later. I continued to take my medicine from home but with a lot of difficulties. I thought the drugs would kill Before CallforLife, Peter felt that the TB medicines were harming his me”. body but healthcare workers on the CallforLife service have reassured him about the safety of these medicines and encouraged him to adhere A month later, amidst his fears about TB treatment, he received a telephone call to all his medicines. Peter has never missed a single dose of his TB from an officer who introduced himself as Patrick. medicines. “Patrick invited me to be enrolled on a digital platform known as CallforLife®, which would provide me with education messages about TB, answer any ‘Whenever I receive advice through the call, it makes me strong and questions about medicine side effects, and remind me to take my medicine on motivates me to take my medicine.